The truth about castor oil

I'm a research geek, and the BBC (BabyCenter) hatred of castor oil got me wondering what the actual evidence is on using castor oil for labor induction. I have never used it and don't ever plan to, but I also want to know if it deserves its terrible BBC (BabyCenter) reputation.

So, here's what I've been able to find. There's actually not a heck of a lot, but do with this what you will.

Spoiler alert, aka tl;dr version: if you are OVERDUE (40+ weeks) there appears to be some evidence that castor oil has about a 50% chance of sending you into labor within 24 hours. One study found women who took castor oil had an increased rate of meconium-stained amniotic fluid, but others found no association at all. Everyone agrees that castor oil is objectively disgusting and there are better ways of inducing labor, like Pitocin, if you are actually overdue.

* The January 2000 issue of the journal "Alternative Therapies" published a study of 103 women who were 40-42 weeks pregnant. 52 women were given 2 oz of castor oil and 48 were not given castor oil. 57.7% of castor oil women went into active labor within 24 hours compared with only 4.2% who did not. This study was performed on women while they were admitted to a hospital in New York, placed on continuous electronic fetal monitoring, attended by OBs, and prescribed castor oil in the hospital setting.

I do not have access to the full article, so this information comes from the abstract only. Note they did NOT discuss outcomes, only the efficacy of castor oil in a 2-oz dose on women who are *overdue.*

* A 2001 Cochrane Review, updated in 2014, discusses the effects of castor oil on pregnancy. They found one small study of 100 women which indicated NO difference in the amount of meconium staining in babies born with castor oil induction vs. those without, and NO difference in reduced Apgar scores. However, they caution that as this was only 1 small study with poor methodology, it warrants more research.

* A 2006 Saudi Medical Journal article replicated the results of the NY doctors by taking 47 women and giving half of them 2 oz castor oil and half none. All women were 40-42 weeks pregnant. The success rate was roughly the same (54.2% went into labor with castor oil, 4.2% did without.) This study also looked at the rate of meconium staining and did NOT find any increase in meconium staining in the castor oil inductions; however, this is a small study. They also cite another study that did show an increase in meconium staining, but noted that it could simply be that the babies were induced with castor oil because they were overdue, which itself increases the risk of meconium staining.

* This is one of my favorites... the May 1959 British Medical Journal article concluded that a soap enema + castor oil is effective at inducing labor in women 38-41 weeks pregnant. However, even in 1959 they noted that castor oil was pretty disgusting and causes significant nausea and diarrhea.

* The October 2009 Australian and New Zealand Journal of Obstetrics and Gynecology has an article entitled "Castor oil for the induction of labour: not harmful, not helpful." They looked at 612 women who were 40+ weeks pregnant attending clinics at the Thai-Burmese border. 205 took castor oil, 407 did not. Unlike the other studies I mentioned, they found it didn't send women into labor any sooner, and they also found no harmful effects on the fetus in terms of meconium staining, Apgar scores, hemorrhage, etc. (I would also like to point out that I'm not super familiar with the Thai-Burmese border, but I wonder if this information is accurately recorded and reported in that area.)

* May 2003 Journal of Maternal-Fetal & Neonatal Medicine presents a case report of a woman who was 39 weeks pregnant and had a previous C-section who ingested a mere 5 mL of castor oil. 45 minutes later, her uterus ruptured. This is pretty anecdotal of course.

I don't care what women do and I've never judged them for doing it, but my dr specifically told me to "not do something stupid like castor oil, that could hurt the baby." That is reason enough for me to never take it.

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